1. Physicians assistants taking on more responsibility.
Under the Affordable Care Act, there will now be community–based organizations that are responsible for coordinating individual care. Within these Accountable Care Organizations, doctors may not have the time to coordinate the necessary appointments, follow-ups and treatments, and some of these functions could be delegated to physician assistants (PA). PAs are professionals who have the authority to diagnose and treat patients beyond their current jurisdiction. In certain specialties, like optometry, it is not uncommon for these professionals to perform many of the functions of an opthamologist, although not all.

You may see some real friction between physicians who have trained for years delegating their responsibility to those with less experience.

2. A shortage of primary care doctors.
Although the number of students graduating from medical school has not dropped significantly , what has dropped is the number of these graduates going into primary care. In fact, over the past few years there has been almost a 27 percent drop in the number of medical graduates opting for primary care professions.

With the growing number of people expected to be able to access the health care system because of increased coverage, the supply side of the equation will clearly fall short in terms of the number of primary care doctors that will be necessary to take care of these patients.

3. Doctors are becoming employees.
As a means of competing to stay afloat and deal with declining reimbursements, many doctors are opting to sell their practices to local hospital systems or insurance companies. This would enable doctors to band together and potentially gain greater negotiating leverage with insurance companies.

The flip side of this; however, is that hospitals and insurance companies are holding doctors more accountable to keep costs down. This could translate into fewer visits by patients to the doctor or more rapid discharge from the hospital.

4. The rise of the virtual doctor.
With increased volume and decreased reimbursement, the role of virtual visits with doctors over video-conferencing or telepresence is starting to catch on. Some insurance companies are starting to reimburse for these visits, and it enables doctors to see more patients, more efficiently without ever requiring a physical visit. The risk to this, is that more mistakes could be made, and more diagnoses could be missed, which would ultimately lead to further complications and higher costs down the road.

5. Doctors being replaced by computers.
Many hospitals are now using software to analyze information from their internal systems to determine where there is potential waste of resources. As a result, many decisions that were typically made by medical professionals are now being delegated to software programs to determine the right course of action.

The most sacred part of health care is the doctor-patient relationship, and there is every indication that the sanctity of this relationship is being eroded. The challenge for the system will ultimately be how to provide the optimal care for each individual without compromising this relationship, and ensuring that patients feel that they are getting what they paid for and rightfully deserve.

The reality is that the current supply of physicians cannot meet the demands of the new construct of the Affordable Care Act, and there needs to be immediate attention to how we will address this imminent manpower issue.

Otherwise, we will be looking back at this scenario 10 years from now, asking ourselves, “What were they thinking when they passed this law?”

Dr. Sreedhar Potarazu is an acclaimed ophthalmologist and entrepreneur who has been recognized as an international visionary in the business of medicine and health information technology. He is the founder of VitalSpring Technologies Inc., a privately held enterprise software company focused on providing employers with applications to empower them to become more sophisticated purchasers of health care. Dr. Potarazu is the founder and chairman of WellZone, a social platform for driving consumer engagement in health.